| NPI | 1407688948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY LONABOCKER Vice President Ops & Strategy 508-345-7059 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-14 |